ObjectiveTo evaluate the association between menopausal hormonal therapy (MHT) and the risk of cardiovascular disease (CVD), according to various regimens, dosages, routes of administration and starting ages of MHT.DesignA population‐based cohort study using the Korean National Health Insurance Services database.SettingNationwide health insurance database.PopulationWomen who reported entering menopause at an age of ≥40 years with no history of CVD in the national health examination.MethodsThe study population comprised 1 120 705 subjects enrolled between 2002 and 2019, categorised according to MHT status (MHT group, n = 319 007; non‐MHT group, n = 801 698).Main outcome measuresIncidence of CVD (a composite of myocardial infarction and stroke).ResultsThe incidence of CVD was 59 266 (7.4%) in the non‐MHT group and 17 674 (5.5%) in the MHT group. After adjusting for confounding factors, an increased risk of CVD was observed with the administration of tibolone (hazard ratio, HR 1.143, 95% CI 1.117–1.170), oral estrogen (HR 1.246, 95% CI 1.198–1.295) or transdermal estrogen (HR 1.289, 95% CI 1.066–1.558), compared with the non‐MHT group; the risk was based on an increased risk of stroke. The risk trends were consistent regardless of the age of starting MHT or the physicians’ specialty. Among tibolone users, a longer period from entering menopause to taking tibolone and the use of any dosage (1.25 or 2.5 mg) were linked with a higher risk of CVD, compared with non‐MHT users.ConclusionsThis nationwide cohort study demonstrated an increased risk of CVD, driven mainly by an increased risk of stroke, among tibolone and oral or transdermal estrogen users, compared with that of non‐MHT users.

中文翻译：

---

绝经期激素治疗对韩国绝经后女性心血管风险的影响：一项全国性队列研究

目的根据 MHT 的不同治疗方案、剂量、给药途径和起始年龄，评估更年期激素疗法 (MHT) 与心血管疾病 (CVD) 风险之间的关联。设计利用韩国国民健康保险服务进行的基于人群的队列研究数据库设置全国医保数据库人群全国健康体检中报告年龄≥40岁进入更年期且无CVD病史的女性研究人群包括2002年至2019年期间入组的1 120 705名受试者，根据MHT状态进行分类（ MHT集团，n= 319 007；非MHT组，n= 801 698)。主要结局指标 CVD 发生率（心肌梗死和中风的复合）。结果非 MHT 组 CVD 发生率为 59 266 例（7.4%），MHT 组 CVD 发生率为 17 674 例（5.5%）。调整混杂因素后，观察到服用替勃龙（风险比，HR 1.143，95% CI 1.117–1.170）、口服雌激素（HR 1.246，95% CI 1.198–1.295）或透皮雌激素（与非 MHT 组相比，HR 1.289，95% CI 1.066–1.558）；该风险是基于中风风险增加。无论开始 MHT 的年龄或医生的专业如何，风险趋势都是一致的。与非 MHT 使用者相比，在替勃龙使用者中，从进入更年期到服用替勃龙的时间较长以及使用任何剂量（1.25 或 2.5 mg）均与较高的 CVD 风险相关。与非 MHT 使用者相比，替勃龙和口服或透皮雌激素使用者中的 CVD 主要由中风风险增加所致。